Healthcare Provider Details

I. General information

NPI: 1487610879
Provider Name (Legal Business Name): ROBERT RAY BROWN FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 11/03/2022
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 MORRIS DR
MINDEN LA
71055-3085
US

IV. Provider business mailing address

208 MORRIS DR
MINDEN LA
71055-3053
US

V. Phone/Fax

Practice location:
  • Phone: 318-377-8260
  • Fax: 318-377-9053
Mailing address:
  • Phone: 318-377-8260
  • Fax: 318-377-9053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPO4055
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: